Impact of bileaflet mitral valve prolapse on quantification of mitral regurgitation with cardiac magnetic resonance: a single-center study.

Détails

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Etat: Public
Version: Final published version
ID Serval
serval:BIB_6435AC4D6991
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Impact of bileaflet mitral valve prolapse on quantification of mitral regurgitation with cardiac magnetic resonance: a single-center study.
Périodique
Journal of cardiovascular magnetic resonance
Auteur(s)
Vincenti G., Masci P.G., Rutz T., De Blois J., Prša M., Jeanrenaud X., Schwitter J., Monney P.
ISSN
1532-429X (Electronic)
ISSN-L
1097-6647
Statut éditorial
Publié
Date de publication
27/07/2017
Peer-reviewed
Oui
Volume
19
Numéro
1
Pages
56
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: epublish
Résumé
To quantify mitral regurgitation (MR) with CMR, the regurgitant volume can be calculated as the difference between the left ventricular (LV) stroke volume (SV) measured with the Simpson's method and the reference SV, i.e. the right ventricular SV (RVSV) in patients without tricuspid regurgitation. However, for patients with prominent mitral valve prolapse (MVP), the Simpson's method may underestimate the LV end-systolic volume (LVESV) as it only considers the volume located between the apex and the mitral annulus, and neglects the ventricular volume that is displaced into the left atrium but contained within the prolapsed mitral leaflets at end systole. This may lead to an underestimation of LVESV, and resulting an over-estimation of LVSV, and an over-estimation of mitral regurgitation. The aim of the present study was to assess the impact of prominent MVP on MR quantification by CMR.
In patients with MVP (and no more than trace tricuspid regurgitation) MR was quantified by calculating the regurgitant volume as the difference between LVSV and RVSV. LVSV <sub>uncorr</sub> was calculated conventionally as LV end-diastolic (LVEDV) minus LVESV. A corrected LVESV <sub>corr</sub> was calculated as the LVESV plus the prolapsed volume, i.e. the volume between the mitral annulus and the prolapsing mitral leaflets. The 2 methods were compared with respect to the MR grading. MR grades were defined as absent or trace, mild (5-29% regurgitant fraction (RF)), moderate (30-49% RF), or severe (≥50% RF).
In 35 patients (44.0 ± 23.0y, 14 males, 20 patients with MR) the prolapsed volume was 16.5 ± 8.7 ml. The 2 methods were concordant in only 12 (34%) patients, as the uncorrected method indicated a 1-grade higher MR severity in 23 (66%) patients. For the uncorrected/corrected method, the distribution of the MR grades as absent-trace (0 vs 11, respectively), mild (20 vs 18, respectively), moderate (11 vs 5, respectively), and severe (4 vs 1, respectively) was significantly different (p < 0.001). In the subgroup without MR, LVSV <sub>corr</sub> was not significantly different from RVSV (difference: 2.5 ± 4.7 ml, p = 0.11 vs 0) while a systematic overestimation was observed with LVSV <sub>uncorr</sub> (difference: 16.9 ± 9.1 ml, p = 0.0007 vs 0). Also, RVSV was highly correlated with aortic forward flow (n = 24, R <sup>2</sup>  = 0.97, p < 0.001).
For patients with severe bileaflet prolapse, the correction of the LVSV for the prolapse volume is suggested as it modified the assessment of MR severity by one grade in a large portion of patients.

Mots-clé
Adult, Aged, Female, Humans, Magnetic Resonance Imaging, Cine, Male, Middle Aged, Mitral Valve/diagnostic imaging, Mitral Valve/physiopathology, Mitral Valve Insufficiency/diagnostic imaging, Mitral Valve Insufficiency/physiopathology, Mitral Valve Prolapse/diagnostic imaging, Mitral Valve Prolapse/physiopathology, Observer Variation, Predictive Value of Tests, Reproducibility of Results, Retrospective Studies, Severity of Illness Index, Stroke Volume, Switzerland, Ventricular Function, Left, Young Adult, Barlow, Cardiac magnetic resonance, Mitral regurgitation, Mitral valve, Prolapse
Pubmed
Web of science
Open Access
Oui
Création de la notice
07/08/2017 9:40
Dernière modification de la notice
20/08/2019 15:20
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